Project Summary/Abstract The incidence of esophageal adenocarcinoma (EAC) has been rising at an alarming rate over the past three decades. Although the absolute number of EAC cases per year remains too low to screen the general population, targeted screening may be appropriate. Heartburn, the primary symptom of gastroesophageal reflux disease (GERD), affects 60 million Americans and can lead to Barrett's esophagus (BE), a pre-malignant condition associated with the greatest risk (30-125x) of developing EAC. Because of the significant number of individuals affected with GERD and BE, the management of these patients has become a public health issue. However, an accepted screening or surveillance program for EAC has not been proposed. The broad, long-term objectives of the proposal are to identify an effective and affordable targeted screening strategy for EAC with early identification and an intervention program which will diminish the burden of this disease. These research goals will be accomplished developing and analyzing an Esophageal AdenoCarcinoma Policy Model (EACMo). A rich mix of complementary methodologies and state of the art simulation techniques will be necessary to achieve the numerous project objectives. Data from numerous sources including Surveillance Epidemiology and End Results (SEER), clinical trial data and the published literature will be used to develop a simulation model. Calibration methodology will be used to systematically fine tune model parameters to produce targeted endpoints (e.g. cancer incidence). Validation will be achieved by having the model reproduce other published data. The specific aims are: Aim 1: Develop and validate the EACMo Aim 2: Estimate contributions of pivotal risk factors to the rise in EAC incidence in the U.S. Aim 3: Identify individuals at high risk for EAC: predictors of Barrett's esophagus Aim 4: Estimate the effectiveness, cost and cost-effectiveness of plausible esophageal adenocarcinoma screening and management programs The health relatedness of the project will be to use the results to design clinical trials, guide policy decisions and inform evidence-based practice guidelines. The multidisciplinary research team assembled for this project has expertise in all aspects of simulation disease modeling, clinical aspects of EAC, and a proven history of research and collaborations.